Participant Registration

Name

Phone

Email

Credit Card

Exp. Date

Credit Card Verification Code

Visa, MC, and DISC: 3-digit number located in the signature pane on the back of your card.
AMEX: 4-digit number located directly above and to the right of the credit card number on the front of your card.

Credit Card Amount

By completing and submitting this application, the participant signing, and additional players names listed hereby acknowledged that they have read and understand the instructions included in this application, and will abide by the rules and regulations of the State of Texas, Health Department, Police and Fire Department, the City of Forth Worth, and any other governmental regulatory agencies of authority. Said participant certified all information contained is true and correct.

The above named company, organization or individual(s) shall indemnify and hold harmelss Midas Touch Ministries Corporation, their employees, agents, representatives, and attorneys from and against any and all claims, demands, actions, liabilities, damages, loses, costs and expenses (including attorney fees, court costs, and other professional fees), or judgments arising out of, or in connection with, any claim, demand or action made by any third party, if such are sustained as a direct or indirect consequence of participant and additional player's listed participation in the Hoopin'Up Hope In Da Hood! Fundraiser tournament.

Participate Signature

Print Name

Date

Parent / Guardian Signature if participant is under 18

Name of Volunteer

Comments

This field is for validation purposes and should be left unchanged.

Hoopin’ Up Hope In Da Hood!

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